十二指腸悪性狭窄に対する腹腔鏡下胃空腸バイパス術に関する検討

Study on laparoscopic gastrojejunostomy for duodenal malignant stenosis

◆要旨：十二指腸悪性狭窄に対する腹腔鏡下胃空腸バイパス術（laparoscopic gastrojejunostomy：以下，LGJ）の有用性につき検討した．2007年4月から2014年10月まで当科施行のLGJ9例と開腹胃空腸バイパス術（open gastrojejunostomy：以下，OGJ）症例21例の周術期合併症，術後短期成績を比較した．またバイパス術後予後因子を後方視的に統計解析した．LGJ群に重篤合併症は認めず, OGJ群に在院死を4例認めた．術後1週間の白血球数とCRPはLGJ群がOGJ群に比し，有意に低値で推移した（各々p＝0.001, p＝0.01）．また術後performance statusの推移もLGJ群がOGJ群に比し，有意に良好であった（p<0.001）．術後常食摂取可能率,在院日数,化学療法導入率,生存期間中央値はLGJ，OGJの順に89％ vs. 71％（p＝0.30），19日（12〜70日） vs. 26日（10〜150日）（p＝0.96），89％ vs. 48％（p＝0.03），291日vs. 126日（p＝0.51）であった．術後予後不良因子は肉眼的腹膜播種および術後化学療法非施行であった．LGJは低侵襲でQOL向上が望める集学的治療に有用な治療法と考えられた．

In this study, we examined the effectiveness of laparoscopic gastrojejunostomy（LGJ） in the treatment of malignant duodenal stenosis. We compared the perioperative complications and postoperative short-term outcomes of 9 patients who underwent LGJ and 21 patients who underwent open gastrojejunostomy（OGJ） at our hospital between April 2007 and October 2014. In addition, we retrospectively analyzed the predictive factors for postoperative prognosis using statistical methods. No serious complications were observed in the LGJ group; however, four in-hospital deaths were observed in the OGJ group. In the week following the surgery, the leukocyte count and C-reactive protein level significantly decreased in the LGJ group compared with that in the OGJ group（p＝0.001 and p＝0.01, respectively）. Moreover, changes in postoperative performance status significantly improved in the LGJ group compared with that in the OGJ group（p<0.001）. Postoperative normal food intake rate, mean length of hospital stay, chemotherapy introduction rate, and median survival time in the LGJ and OGJ groups were 89％ vs. 71％（p＝0.30）, 19（12-70） days vs. 26（10-150） days （p＝0.96）, 89％ vs. 48％（p ＝ 0.03）, and 291 days vs. 126 days（p＝0.51）, respectively. Macroscopic peritoneal dissemination and not receiving postoperative chemotherapy were identified as predictive factors for poor postoperative prognosis. We believe that LGJ is a useful multidisciplinary treatment method which is minimally invasive and improves quality of life.